Got a Workers’ Comp Dispute? There’s a Process for That

As a blogger covering a topic that is admittedly not all that dynamic, I constantly scan industry publications for inspiration. I’m looking for hot-button issues, revolutionary studies or, at the very least, someone with something interesting to say. I gotta admit my heart skipped a beat – maybe half a beat – when I saw this headline: “How Does the Workers’ Compensation Act Protect You?”

With 13 years’ experience at the state’s leading provider of workers’ compensation, I understand the benefits of coverage. I know that workers’ comp protects employers from lawsuits filed by injured workers. And you don’t have to convince me that the lifetime income benefits offered through the system are employees’ best protection from the consequences of on-the-job accidents. I figured, “This author gets it, too.” And he did…until he suggested injured workers might want an attorney on their side to deal with their insurance company.

I would never argue that litigation has absolutely no place in workers’ compensation. Sadly, it is occasionally the only way to ensure all parties are treated fairly. But it should be a last resort, not the status quo, as it was in Texas more than 20 years ago.

In the late 1980s, our workers’ compensation system was broken. Rates were skyrocketing, carriers were abandoning the state, and employers were left holding the bag. A high percentage of claim disputes were resolved in court, and attorneys were involved in nearly 50 percent of all but the smallest claims.

With our system in crisis mode, the Legislature stepped in and passed Senate Bill 1. Among the bill’s many provisions was the creation of an administrative process for resolving disputes. The process brings injured workers, insurance carriers and employers together with the goal of resolving disputes outside the courts.

The next major overhaul of the Texas workers’ compensation system happened in 2005, when the Legislature passed House Bill 7. The bill mandated the creation of the Office of Injured Employee Counsel (OIEC) and charged it with advocating for injured workers. OIEC provides free ombudsmen to assist injured workers through the administrative dispute process.

If you are an injured worker in Texas, you’re not alone. Along with OIEC’s assistance, your insurance carrier is there to soften the impact of medical bills and lost wages. Your doctor is there to help you get well and back on the job. And the State of Texas is there to ensure you, your employer and your insurance carrier are treated fairly throughout the process.

In our next post, Grace Fogle of our special claim services team will explain the first step in the dispute resolution process: the benefit review conference.